The barriers dentists face to communicate cancer diagnosis:self-assessment based on SPIKES protocol

This study aimed to characterize the barriers faced by Brazilian dentists to deliver bad news (DBN) about oral and oropharyngeal cancer diagnoses to patients by using a questionnaire based on the guidelines of the SPIKES protocol. This was an observational cross-sectional study. The questionnaire contained 27 questions based on the SPIKES protocol, which were answered in the SurveyMonkey platform. A total of 186/249 dentists answered the questionnaire. The main specialties reported were 36.02% oral medicine, 21.5% oral pathology, and 9.13% oral and maxillofacial surgery. A total of 44.6% expressed concern about the patient?s emotional reactions, and 46.24% of respondents had never participated in any specific training to communicate bad news. The lack of training and low confidence in dealing with patients? emotional reactions dentists were considered the greatest barriers to DBNs. Moreover, most dentists who participated in the survey believe that a protocol to guide the communication of bad news would be useful for clinical practice. For those protocols to be used by dentists, training is critical for these protocols to be incorporated by professionals

Antileukotriene Reverts the Early Effects of Inflammatory Response of Distal Parenchyma in Experimental Chronic Allergic Inflammation

Aims. Compare the effects of montelukast or dexamethasone in distal lung parenchyma and airway walls of guinea pigs (GP) with chronic allergic inflammation. Methods. GP have inhaled ovalbumin (OVA group-2x/week/4weeks). After the 4th inhalation, GP were treated with montelukast or dexamethasone. After 72 hours of the 7th inhalation, GP were anesthetised, and lungs were removed and submitted to histopathological evaluation. Results. Montelukast and dexamethasone treatments reduced the number of eosinophils in airway wall and distal lung parenchyma compared to OVA group (P < 0.05). On distal parenchyma, both treatments were effective in reducing RANTES, NF-kappa B, and fibronectin positive cells compared to OVA group (P < 0.001). Montelukast was more effective in reducing eotaxin positive cells on distal parenchyma compared to dexamethasone treatment (P < 0.001), while there was a more expressive reduction of IGF-I positive cells in OVA-D group (P < 0.001). On airway walls, montelukast and dexamethasone were effective in reducing IGF-I, RANTES, and fibronectin positive cells compared to OVA group (P < 0.05). Dexamethasone was more effective in reducing the number of eotaxin and NF-kappa B positive cells than Montelukast (P < 0.05). Conclusions. in this animal model, both treatments were effective in modulating allergic inflammation and remodeling distal lung parenchyma and airway wall, contributing to a better control of the inflammatory response.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ São Paulo, Sch Med, Dept Med, BR-01246903 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biol Sci, BR-09972270 Diadema, SP, BrazilUniversidade Federal de São Paulo, Dept Biol Sci, BR-09972270 Diadema, SP, BrazilCNPq: LIM-20-HC-FMUSPWeb of Scienc

Cirurgia endoscópica intrarrenal combinada (ECIRS) em posição galdakao-valdívia modificada: um relato de caso / Endoscopic combined intrarenal surgery (ECIRS) in galdakao modified supine valdivia position: a case report

Introdução: A nefrolitíase é uma patologia de alta prevalência. Possui importante morbidade por complicações agudas, relacionadas a obstrução de vias urinárias e quadros de insuficiência renal, bem como quadros infecciosos que podem evoluir à sepsis. Classicamente seu tratamento é cirúrgico e tem-se a nefrolitotomia percutânea (NPC) como padrão ouro para cálculos renais maiores que 2 cm.  Relato de caso: Paciente masculino, 48 anos, com repetidos quadros de infecção urinária. A investigação foi realizada com exames laboratoriais e de imagem. Possui sobrepeso, hipertensão leve, sem outras comorbidades. Apresentando cálculo coraliforme, complexo à esquerda, foi submetido a abordagem endoscópica combinada, ureteroscópica e percutânea em posição supina modificada, com completa extirpação de cálculos, com alta no segundo dia de pós-operatório, retornando em 45 dias para retirada de duplo jota, com boa evolução

Low-level laser therapy in acute pain: a systematic review of possible mechanisms of action and clinical effects in randomized placebo-controlled trials,”

ABSTRACT Objective: The aim of this study was to review the biological and clinical short-term effects of low-level laser therapy (LLLT) in acute pain from soft-tissue injury. Background Data: It is unclear if and how LLLT can reduce acute pain. Methods: Literature search of (i) controlled laboratory trials investigating potential biological mechanisms for pain relief and (ii) randomized placebo-controlled clinical trials which measure outcomes within the first 7 days after acute soft-tissue injury. Results: There is strong evidence from 19 out of 22 controlled laboratory studies that LLLT can modulate inflammatory pain by reducing levels of biochemical markers (PGE 2 , mRNA Cox 2, IL-1␤, TNF␣), neutrophil cell influx, oxidative stress, and formation of edema and hemorrhage in a dosedependent manner (median dose 7.5 J/cm 2 , range 0.3-19 J/cm 2 ). Four comparisons with non-steroidal anti-inflammatory drugs (NSAIDs) in animal studies found optimal doses of LLLT and NSAIDs to be equally effective. Seven randomized placebo-controlled trials found no significant results after irradiating only a single point on the skin overlying the site of injury, or after using a total energy dose below 5 Joules. Nine randomized placebo-controlled trials (n = 609) were of acceptable methodological quality, and irradiated three or more points and/or more than 2.5 cm 2 at site of injury or surgical incision, with a total energy of 5.0-19.5 Joules. Results in these nine trials were significantly in favor of LLLT groups over placebo groups in 15 out of 18 outcome comparisons. Poor and heterogeneous data presentation hampered statistical pooling of continuous data. Categorical data of subjective improvement were homogeneous (Q-value = 7.1) and could be calculated from four trials (n = 379) giving a significant relative risk for improvement of 2.7 (95% confidence interval [CI], 1.8-3.9) in a fixed effects model. Conclusion: LLLT can modulate inflammatory processes in a dose-dependent manner and can be titrated to significantly reduce acute inflammatory pain in clinical settings. Further clinical trials with adequate LLLT doses are needed to precisely estimate the effect size for LLLT in acute pain

Computational shelf-life dating : complex systems approaches to food quality and safety

Shelf-life is defined as the time that a product is acceptable and meets the consumers expectations regarding food quality. It is the result of the conjunction of all services in production, distribution, and consumption. Shelf-life dating is one of the most difficult tasks in food engineering. Market pressure has lead to the implementation of shelf-life by sensory analyses, which may not reflect the full quality spectra. Moreover, traditional methods for shelf-life dating and small-scale distribution chain tests cannot reproduce in a laboratory the real conditions of storage, distribution, and consumption on food quality. Today, food engineers are facing the challenges to monitor, diagnose, and control the quality and safety of food products. The advent of nanotechnology, multivariate sensors, information systems, and complex systems will revolutionize the way we manage, distribute, and consume foods. The informed consumer demands foods, under the legal standards, at low cost, high standards of nutritional, sensory, and health benefits. To accommodate the new paradigms, we herein present a critical review of shelf-life dating approaches with special emphasis in computational systems and future trends on complex systems methodologies applied to the prediction of food quality and safety.Fundo Europeu de Desenvolvimento Regional (FEDER) - Programa POS-ConhecimentoFundação para a Ciência e a Tecnologia (FCT) - SFRH/BPD/26133/2005, SFRH/ BPD/20735/200

Auxílio-doença no curso do aviso prévio: serviço social na assistência ao paciente com síndrome da imunodeficiência adquirida/ Disease aid in the course of prior notice: social work in patient assistance with acquired immunodeficiency syndrome

A Síndrome da Imunodeficiência Adquirida (AIDS) é uma doença causada pelo Vírus da Imunodeficiência Humana (HIV). Objetivo: Relatar a assistência prestada pelo Serviço Social no caso específico de uma paciente recém diagnosticada e hospitalizada em decorrência do HIV/AIDS, que estava em observância do aviso prévio. Metodologia: Estudo descritivo, no formato de relato de experiência, ocorrido no durante o Programa de Residência Multiprofissional em CuidadosContinuados Integrados/PREMUS-CCI, em um hospital de ensino no município de Campo Grande/MS. Resultado: O benefício previdenciário de auxílio-doença é concedido ao segurado do Instituto Nacional do Seguro Social (INSS) que comprove, em perícia médica, estar temporariamente incapaz para atividade laborativa, em decorrência de doença ou acidente, possuindo algumas peculiaridades em relação ao HIV/AIDS e a situação de aviso prévio. Sendo o Serviço Social necessário nestes casos, tendo em vista que os pacientes vivendo com HIV/AIDS apresentam demandas em saúde que não se limitam às questões relacionadas apenas aos aspectos biológico-médicos.Necessitando de atendimento de forma biopsicossocial, que atendam suas demandas sociais, trabalhistas e previdenciárias. Conclusão: O Serviço Social, com ações voltadas à informação e orientação da população, trabalha na perspectiva da viabilização dos direitos sociais, garantidos em legislações especificas

Uso de drogas e o aumento das infecções sexualmente transmissíveis: uma revisão sistemática: Drug use and the increase in sexually transmitted infections: a systematic review

Populações de usuários de drogas têm sido associadas a epidemias de infecções ou Infecções Sexualmente Transmissíveis, especialmente a infecção pelo HIV (que está associada a drogas injetáveis, uso de equipamentos contaminados para drogas injetáveis e sexo inseguro). A droga mais associada às DSTs é a cocaína fumável de base livre (crack), devido ao aumento dos comportamentos sexuais de risco. Diante disso, o presente estudo teve como objetivo compreender o impacto do uso de drogas no aumento das infecções sexualmente transmissíveis. Para isso, adotou-se como metodologia a revisão sistemática de literatura, realizando buscas nas bases de dados Scielo, Pubmed e BVS/Medline a partir do uso de descritores DeCS/MeSH e aplicação de critérios de inclusão e exclusão. A partir da análise e interpretação dos dados, concluiu-se que que pessoas que fazem uso abusivo de drogas lícitas ou ilícitas, sejam elas mulheres, homens, adolescentes, jovens, adultos, idosos, em situação de rua ou não, tendem a desenvolver comportamentos vulneráveis que pode resultar em IST. Somado a isso, enquanto comportamento de risco, tem-se a preferência por não usar preservativo, seja em relações sexuais com pessoas monogâmicas como com dois ou mais parceiros. Nesses casos, tanto o uso exacerbado de drogas como a falta de informação sobre comportamento sexual demonstram-se insuficientes

Alterações cognitivas na infecção pelo HIV: uma revisão sistemática: Cognitive changes in HIV infection: a systematic review

Provocada pelo vírus da imunodeficiência humana, com a síndrome da imunodeficiência adquirida, numa pessoa tem o seu sistema imunológico prejudicado, tornando-se suscetível a outras doenças e infecção. Tem-se a estimativa de que 50% dos infectados com o referido vírus podem sofrer alterações cognitivas. Diante disso, este estudo tem como objetivo refletir sobre mudanças estruturais cerebrais e comprometimento cognitivo em pacientes com HIV. Portanto, trata-se de uma revisão sistemática de literatura, desenvolvida a partir da seleção de estudos nas bases de dados Scielo, Pubmed e BVS/Medline a partir do uso de descritores DeCS/MeSH e aplicação de critérios de inclusão e exclusão. Após a análise e interpretação dos dados, concluiu-se que há uma significativa prevalência de HAND em adultos infectados por HIV, no que se refere a alterações cognitivas, especialmente entre pacientes do sexo feminino, de baixa escolaridade e renda, com diagnóstico tardio e baixa quantidade de linfócitos CD4 no início do tratamento. Entre essas pessoas, revelam-se comprometimentos quanto à memória, atenção, controle de impulsos, velocidade de processamento e motora, dentre outros

Search for invisible decays of the Higgs boson produced via vector boson fusion in proton-proton collisions at s\sqrt{s} = 13 TeV

A search for invisible decays of the Higgs boson produced via vector boson fusion (VBF) has been performed with 101  fb$^{-1}$ of proton-proton collisions delivered by the LHC at $\sqrt{s}$ =13  TeV and collected by the CMS detector in 2017 and 2018. The sensitivity to the VBF production mechanism is enhanced by constructing two analysis categories, one based on missing transverse momentum and a second based on the properties of jets. In addition to control regions with Z and W boson candidate events, a highly populated control region, based on the production of a photon in association with jets, is used to constrain the dominant irreducible background from the invisible decay of a Z boson produced in association with jets. The results of this search are combined with all previous measurements in the VBF topology, based on data collected in 2012 (at $\sqrt{s}$ =8  TeV), 2015, and 2016, corresponding to integrated luminosities of 19.7, 2.3, and 36.3  fb$^{-1}$, respectively. The observed (expected) upper limit on the invisible branching fraction of the Higgs boson is found to be 0.18 (0.10) at the 95% confidence level, assuming the standard model production cross section. The results are also interpreted in the context of Higgs-portal models

Observation of the Bc+_\mathrm{c}^+ Meson in Pb-Pb and pp Collisions at sNN\sqrt{s_{\mathrm{NN}}} = 5.02 TeV and Measurement of its Nuclear Modification Factor

The B$_\mathrm{c}^+$ meson is observed for the first time in heavy ion collisions. Data from the CMS detector are used to study the production of the B$_\mathrm{c}^+$ meson in lead-lead (Pb-Pb) and proton-proton (pp) collisions at a center-of-mass energy per nucleon pair of $\sqrt{s_{\mathrm{NN}}}$ = 5.02 TeV , via the B$_\mathrm{c}^+$ → (J/ψ → μ$^+$μ$^−$)μ$^+$ν$_μ$ decay. The B$_\mathrm{c}^+$ nuclear modification factor, derived from the PbPb-to-pp ratio of production cross sections, is measured in two bins of the trimuon transverse momentum and of the PbPb collision centrality. The B$_\mathrm{c}^+$meson is shown to be less suppressed than quarkonia and most of the open heavy-flavor mesons, suggesting that effects of the hot and dense nuclear matter created in heavy ion collisions contribute to its production. This measurement sets forth a promising new probe of the interplay of suppression and enhancement mechanisms in the production of heavy-flavor mesons in the quark-gluon plasma